Analysis Of Clinical Factors Related To Bronchopulmonary Dysplasia And Extrapulmonary Complications In Preterm Infants

Objective:This Article is aimed to analyze the clinical factors related to bronchopulmonary dysplasia(BPD)in preterm infants and explore the possible clinical factors that may cause extrapulmonary complications in preterm infants with BPD.The fundamental purpose is to prevent the occurrence of extrapulmonary complications in preterm infants with BPD,and provide the helpful guidance for the systematic management of preterm infants with BPD.Methods:By retrospectively investigating the preterm infants with the gestational age <32 weeks and birth weight <1500g who born at the neonatal department of Qingdao University Affiliated Hospital from January 2016 to December 2018.The 126 preterm infants diagnosed with BPD was selected as the case group(BPD group),and contemporaneous 139 preterm infants without BPD comparable basic data(such as gestational age,birth weight,gender,etc.)who met the inclusion criteria comparable basic data(such as gestational age,birth weight,gender,etc.)and met the inclusion criteria was selected as the control group(non-BPD group).After collecting the clinical data and the occurrence of extrapulmonary complications of preterm infants in two groups,statistical comparative analysis was carried out.In order to analyze the clinical factors related to the occurrence of extrapulmonary complications in the BPD group,subgroups were performed for the preterm infants in the BPD group: The 48 cases of BPD preterm infants with retinopathy of prematurity(ROP)were divided into ROP case group,which was recorded as Group BPD(ROP+);The 33 cases of BPD preterm infants with brain injury in premature infants(BIPI)were divided into BIPI case group,which was recorded as Group BPD(BIPI+);The 25 cases of BPD preterm infants with parenteral nutrition associated cholestasis(PNAC)were divided into PNAC case group,which was recorded as group BPD(PNAC+);The 22 cases of BPD premature infants with MBD were divided into metabolic bone disease(MBD)case group,which was recorded as group BPD(MBD+);And the 45 cases of BPD premature infants without ROP,BIPI,PNAC,and MBD were divided into BPD control group,which was recorded as BPD(-).Through comparative analysis of clinical data of Group BPD(ROP+),Group BPD(BIPI +),Group BPD(PNAC+),Group BPD(MBD+)and group BPD(-)to find the differences.Results:(1)The in vitro fertilization-embryo transfer rate and prenatal infection rate of the mothers in the BPD group were higher than those in the non-BPD group,and the differences were statistically significant(P<0.05).The BPD group have lower 1-minute Apgar score and 5-minute Apgar score,longer invasive ventilation time,non-invasiveventilation time and mask / nasal catheter oxygenation time,higher infection rate after birth and blood transfusion rate,more time blood transfusions than that in non-BPD group.Furthermore,the hospitalization time was longer in BPD group.And all the differences were statistically significant(P <0.05).(2)The incidence rate of ROP,BIPI,PNAC,and MBD in the BPD group were higher than those in the non-BPD group,the differences were statistically significant(P<0.05).(3)The smaller gestational age,lower birth weight,invasive ventilation time,noninvasive ventilation time,lower Apgar scores of 1 or 5 minutes,multiple blood transfusions,and prenatal infection are risk factors for ROP in preterm infants with BPD,and all the differences were statistically significant(P <0.05);In the logistic regression model,the noninvasive ventilation time is the risk factor for ROP in preterm infants with BPD(OR?1.187,P <0.05),while gestational age is a protective factor for ROP in preterm infants with BPD(OR?0.876,P <0.05).(4)The smaller gestational age,lower birth weight,lower Apgar scores at 1 or 5minutes,invasive ventilation time,noninvasive ventilation time,multiple blood transfusions,prenatal infections and postpartum infections are the risks of BIPI in preterm infants with BPD,and all the differences were statistically significant(P <0.05).In the logistic regression model,the noninvasive ventilation is the risk factor for the occurrence of BIPI in preterm infants with BPD(OR?1.278,P <0.05),while the 1-minute Apgar score is a protective factor for BIPI in preterm infants with BPD(OR?0.520,P <0.05).(5)The smaller gestational age,lower birth weight and 1-minute Apgar score,invasive ventilation time,noninvasive ventilation time,fasting time,the continuous supply time of intravenous nutrition,the start time of intestinal microfeeding,postnatal infection is risk factors of PNAC in preterm infants with BPD(P <0.05);In logistic regression model,the continuous supply time of intravenous nutrition(OR?1.146,P<0.05),the start time of enteral microfeeding(OR?5.438,P <0.05)and postnatal Infection(OR?7.046,P <0.05)are the risk factors for PNAC in preterm infants with BPD.(6)The small gestational age,low birth weight,lower Apgar scores of 1 or 5minutes,invasive ventilation time,noninvasive ventilation time,fasting time and the continuous supply time of intravenous nutrition,the start time of intestinal microfeeding,the addition time of vitamin D,postnatal infection,the used of hormones and diuretics is a risk factor for MBD in preterm infants with BPD(P <0.05);In Logistic regression model,noninvasive ventilation time(OR?2.129,P <0.05),the addition time of vitamin D(OR?4.257,P <0.05)is the risk factors for MBD in preterm infants with BPD.Conclusions:(1)That the oxygen therapy,mechanical ventilation,asphyxia,infection and blood transfusion are the risk factors for BPD in preterm infants.(2)Preterm infants with BPD are more likely to develop ROP,BIPI,PNAC,and MBD than those preterm infants without BPD.(3)Try to avoid premature birth,shorten the time of oxygen therapy or mechanical ventilation,start enteral microfeeding as soon as possible,shorten the application of intravenous nutrition,add the vitamin D timely and prevent infections actively,which can reduce the incidence of extrapulmonary complications in preterm infants with BPD.